Authors: Bicket M C et al.
Anesthesiology, February 2026 144(2):431–440
Summary
This large national cohort study evaluated trends in the use of medications for opioid use disorder (MOUD) among commercially insured U.S. surgical patients between 2016 and 2022. The motivation for the study stems from a growing clinical challenge: perioperative pain management in patients receiving MOUD remains poorly standardized, despite increasing exposure to these medications in surgical populations.
Using the Merative MarketScan Commercial Database, the authors analyzed over 8.1 million surgical admissions involving more than 5 million adults aged 18 to 64 years undergoing one of 1,083 major surgical procedures. MOUD use was defined as receipt of medication within 1 to 180 days before surgery. Adjusted logistic regression models accounted for demographics and comorbidities to estimate annual trends, while procedure-level analyses identified surgeries with the highest prevalence of MOUD use.
Across the study period, the adjusted prevalence of MOUD use nearly doubled, increasing from 55.2 per 100,000 procedures in 2016 to 99.8 per 100,000 procedures in 2022. Buprenorphine accounted for the vast majority of MOUD exposure, representing 84% of cases. Methadone and naltrexone were used far less frequently.
MOUD use was not evenly distributed across surgical types. Procedures with the highest prevalence included debridement procedures, shoulder arthroplasty, lower extremity amputation, and open repair of hip or pelvic fractures. Many of these operations are associated with chronic pain, trauma, or both—clinical contexts where opioid exposure and opioid use disorder are more common.
The authors conclude that the increasing prevalence of MOUD among surgical patients underscores an urgent need for clear, evidence-based perioperative management guidelines. Given the concentration of MOUD use in orthopedic and trauma-related surgeries, these specialties may be particularly impacted, though the findings are broadly relevant to anesthesiology practice.
Key Points
• MOUD use among commercially insured surgical patients nearly doubled from 2016 to 2022
• Buprenorphine accounted for the majority of perioperative MOUD exposure
• Orthopedic and trauma-related procedures showed the highest rates of MOUD use
• Lack of standardized perioperative pain guidelines for MOUD patients represents a growing gap in care
• Findings highlight the need for anesthesia-led protocols addressing perioperative pain and relapse risk
Thank you to Anesthesiology for allowing us to summarize and discuss this important study on evolving perioperative challenges related to opioid use disorder.